Impact of Title X changes on family planning access for Texas teens

In-depth interviews with program administrators at publicly funded family planning organizations in Texas show that changes to Title X are decreasing access to services for teens and the quality of those services. The findings, the authors say, could have national implications as the 2019 Title X regulations are litigated.

Methods
Published in the Journal of Adolescent Health, the data from the interviews focused on four main themes: (1) the importance of confidential and accessible services to minor teens; (2) strategies organizations used to make those services available; (3) variability in organizations’ parental consent requirements; and (4) the impact of funding changes on organizations. The interviews were conducted in three waves, from February 2012 to February 2015. The aim was to explore changes in the provision of confidential reproductive health services after the implementation of state policies that cut and reorganized public family planning funding, including Title X.

Through Title X, which supports nearly 4,000 health centers nationwide, teens have historically been able to receive confidential and low-cost sexual and reproductive health services. The clinics are a key point of access for teens in the 24 states that do not explicitly allow them to consent to their own contraception because federal rules supersede state parental consent laws.

In the first wave for the study (February to July 2012), the authors invited respondents from 37 publicly funded family planning organizations to take part in interviews. In the second wave (May to September 2013), the 32 organizations still providing family planning services were recontacted and two other organizations that had started providing services through Title X or state-funded programs were contacted. The third wave, conducted after Texas had implemented new family planning programs, included 45 organizations providing family planning services, 10 of which were new to the state family planning programs.

In-person or phone interviews were conducted with clinic staff members knowledgeable about the organizations’ family planning programs and services. The included administrators, directors of clinical services, medical directors, or other clinicians. Each interview lasted about an hour. The authors asked the interviewees to describe changes in the number of teens seeking care and to what they attributed these changes. They also asked how the organizations were documenting parental consent for teens at sites that never had or lost Title X funding and any related challenges.

Findings
Overall, 34 of 47 organizations received Title X funding before 2013 and 79% lost funding during the study period. Respondents at these organizations frequently reported a decrease in teen clients, which they attributed to loss of confidential services previously guaranteed under Title X.

As the number of Title X-funded sites decreased, availability of confidential services became inconsistent. Most organizations offered confidential testing for pregnancy and sexually transmitted infections, but availability of confidential contraceptive services varied across and within organizations and often depended on insurance coverage.

The authors noted that “efforts to clarify and develop protocols for obtaining parental consent and train and retrain staff required extra time and resources for many organizations that lost Title X funding or were new participants in the state programs.” They said of the interviewees’ experience that they “illustrate an ominous picture of what might happen to providers and their teen clients elsewhere if the Title X rules remain in effect.”